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Int J Cancer. 2015 Dec 1;137(11):2715-28. doi: 10.1002/ijc.29643. Epub 2015 Jul 6.

Dietary fat, fat subtypes and hepatocellular carcinoma in a large European cohort.

Author information

  • 1International Agency for Research on Cancer (IARC-WHO), Lyon, France.
  • 2Department of Epidemiology, Rollins School of Public Health, , Winship Cancer Institute, Emory University, Atlanta, GA.
  • 3Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
  • 4Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
  • 5Department of Epidemiology, Harvard School of Public Health, Boston, MA.
  • 6Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.
  • 7Department of Public Health, Aarhus University, Aarhus, Denmark.
  • 8Danish Cancer Society Research Center, Copenhagen, Denmark.
  • 9Inserm, Centre for Research in Epidemiology and Population Health, U1018, Gustave Roussy Institute, F-94805, Villejuif, France.
  • 10Institut Gustave-Roussy (IGR), Paris South University, UMRS 1018, F-94805, Villejuif, France.
  • 11Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
  • 12Hellenic Health Foundation, Athens, Greece.
  • 13Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy.
  • 14Dipartimento Di Medicina Clinica E Chirurgia, Federico II University, Naples, Italy.
  • 15Epidemiology and Prevention Unit, Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
  • 16Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin and Città Della Salute E Della Scienza Hospital-CPO Piedmont, Turin, Italy.
  • 17Department of Epidemiology, Local Health Unit To3, Turin, Italy.
  • 18Cancer Registy and Histopathology Unit, "Civic - M.P. Arezzo" Hospital, ASP, Ragusa, Italy.
  • 19Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
  • 20Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.
  • 21Department of Epidemiology and Biostatistics, the School of Public Health, Imperial College London, London, United Kingdom.
  • 22Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
  • 23Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
  • 24Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
  • 25Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, the Arctic University of Norway, Tromsø, Norway.
  • 26Cancer Registry of Norway, Oslo, Norway.
  • 27Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
  • 28Group of Genetic Epidemiology, Folkhälsan Research Center, Helsinki, Finland.
  • 29Navarre Public Health Institute, Pamplona, Spain.
  • 30CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain.
  • 31Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Institut Català D'oncologia, L'hospitalet De Llobregat, Spain.
  • 32Department of Epidemiology, Murcia Regional Health Authority, IMIB-Arrixaca, Murcia, Spain.
  • 33Public Health Direction and Biodonostia Research Institute and CIBERESP, Basque Regional Health Department, San Sebastian, Spain.
  • 34Public Health Directorate, Asturias, Spain.
  • 35Department of Odontology, Umeå University, Umeå, Sweden.
  • 36Department of Clinical Sciences, Division of Internal Medicine, Lund University, Sweden.
  • 37Department of Gastroenterology and Nutrition, Skåne University Hospital, Malmö, Sweden.
  • 38Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden.
  • 39School of Clinical Medicine, Clinical Gerontology Unit, University of Cambridge, Cambridge, United Kingdom.
  • 40Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
  • 41MRC Epidemiology Unit, Cambridge, United Kingdom.
  • 42Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, London, United Kingdom.


The role of amount and type of dietary fat consumption in the etiology of hepatocellular carcinoma (HCC) is poorly understood, despite suggestive biological plausibility. The associations of total fat, fat subtypes and fat sources with HCC incidence were investigated in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, which includes 191 incident HCC cases diagnosed between 1992 and 2010. Diet was assessed by country-specific, validated dietary questionnaires. A single 24-hr diet recall from a cohort subsample was used for measurement error calibration. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated from Cox proportional hazard models. Hepatitis B and C viruses (HBV/HCV) status and biomarkers of liver function were assessed separately in a nested case-control subset with available blood samples (HCC = 122). In multivariable calibrated models, there was a statistically significant inverse association between total fat intake and risk of HCC (per 10 g/day, HR = 0.80, 95% CI: 0.65-0.99), which was mainly driven by monounsaturated fats (per 5 g/day, HR = 0.71, 95% CI: 0.55-0.92) rather than polyunsaturated fats (per 5 g/day, HR = 0.92, 95% CI: 0.68-1.25). There was no association between saturated fats (HR = 1.08, 95% CI: 0.88-1.34) and HCC risk. The ratio of polyunsaturated/monounsaturated fats to saturated fats was not significantly associated with HCC risk (per 0.2 point, HR = 0.86, 95% CI: 0.73-1.01). Restriction of analyses to HBV/HCV free participants or adjustment for liver function did not substantially alter the findings. In this large prospective European cohort, higher consumption of monounsaturated fats is associated with lower HCC risk.

© 2015 UICC.


European populations; cohort study; dietary fats; hepatocellular carcinoma

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